HYPERTENSION MEDICATIONS COVERED

BY THE DRUG PLAN

Generic Drug Name

Brand Name

Presentation

Maximum
Month Supply

Description

Amlodipine

Amlodipine

Tablets, 10 mg

30

Description not
available

Amlodipine

Amlodipine

Tablets, 5 mg

30

Atenolol

Atenolol

Tablets, 100mg

30

Large, round, peach

colored tablet;
scored

Atenolol

Atenolol

Tablets, 50mg

30

Small, round, peach

colored tablet;
scored

Captopril

Captopril

Tablets, 50mg

270

Tablets, 10mg

60

Pink triangle tablet;

scored; markings
APO EN10
Peach triangle
tablet; scored;
markings APO
EN20

Enalapril

Enalapril

White round tablet;

scored

Enalapril

Enalapril

Tablets, 20mg

60

Felodipine

Felotensil

Tablets, 10mg

30

78 NPDP Patient Guide

Round white tablet;

scored

Description not
available

Generic Drug Name

Brand Name

Presentation

Maximum
Month Supply

Description

Felopidine

Felotensil

Tablets, 5mg

30

Description not
available

Furosemide

ApoFurosemide

Tablets, 40mg

60

Furosemide

Furosemide

Suspension,
10mg/ml

240

Description not
available

Hydrochlorothiazide
(HCTZ)

Apo-Hydro

Tablets, 25mg

30

Pale pink, round,

flat-faced tablet;
scored

Indapamide

Natrilix SR

Tablets, SR
1.5mg

90

Lisinopril

ApoLisinopril

Tablets, 10mg

30

Lisinopril

Lisorem

Tablets, 20mg

30

Yellow, round, flatfaced tablet; scored

White, round,
coated tablet

Pink, oval, biconvex

tablet

Pink round tablet;

scored

NPDP Patient Guide

79

Generic Drug Name

Brand Name

Presentation

Maximum
Month Supply

Lisinopril/HCTZ

ApoLisinopril/
HCTZ

Tablets,
20mg/12.5mg

60

Metoprolol

ApoMetoprolol

Tablets, 50mg

60

Metoprolol

ApoMetoprolol

Tablets, 100mg

120

Nifedipine LA

Adalat OROS

Tablets, 30mg

30

Rose pink, round

film-coated tablet;
markings Adalat
30

Nifedipine LA

Adalat OROS

Tablets, 60mg

60

Rose pink, round,

film-coated tablet;
markings Adalat,
60

80 NPDP Patient Guide

Description

White oblong
tablet; markings
APO 20 12.5
Description not
available

White round tablet;

scored; markings
APO 100

Generic Drug Name

Perindopril

Brand Name

Coversyl

Presentation

Maximum
Month Supply

Tablets, 10mg

30

Description

Green round,
biconvex filmcoated tablet with
markings (heart and
double triangles).

Light green, rod

shaped, film coated
tablet, engraved
with double
triangles on one
face and scored on
both edges.

Perindopril

Coversyl

Tablets, 5 mg

30

Perindopril/
Amlodipine

Coveram
10/10

Tablets,
10mg/10mg

30

Round, white
tablet; markings
10/10, double
triangles- logo

Perindopril/
Amlodipine

Coveram
10/5

Tablets,
10mg/5mg

30

White triangle
tablet; markings
10/5; double
triangles-logo

NPDP Patient Guide

81

Generic Drug Name

Brand Name

Presentation

Maximum
Month Supply

Perindopril/
Amlodipine

Coveram

Tablets,
5mg/10mg

30

White square
tablet; markings
5/10; double
triangles-logo

Coveram

Tablets,
5mg/5mg

30

White oblong
tablet; markings
5/5; double
triangles-logo

Preterax 2.5

Tablets,
2.5mg/1.25mg

30

White oblong
coated tablet;
scored

Preterax 5

Tablets,
5mg/1.25mg

30

White small oblong

shaped coated
tablet

Preterax 10

Tablets,
10mg/2.5mg

30

Perindopril/
Amlodipine

Perindopril/
Indapamide

Perindopril/
Indapamide

Perindopril/
Indapamide

82 NPDP Patient Guide

Description

White round film

coated tablet

Generic Drug Name

Brand Name

Presentation

Maximum
Month Supply

Potassium Chloride

Apo-K

Tablets, 600mg

60

Orange, round, film

coated tablet;
markings APO-K
600

Telmisartan

Micardis

Tablets, 80mg

28

White oval tablet;

markings
LOGO,52H

Telmisartan/HCTZ

Micardis Plus

Tablets,
80mg/12.5mg

28

Valsartan

Diovan

Tablets, 80mg

30

Pink, round, filmcoated tablet;

scored; markings
NVR, DV

Valsartan

Diovan

Tablets, 160mg

30

Tan oblong-shaped,
markings NVR, DX

Description

One side white, one

side pink; tablet
oval shape;
markings H8;
LOGO

NPDP Patient Guide

83

Generic Drug Name

Brand Name

Presentation

Maximum
Month Supply

Valsartan

Diovan

Tablets, 320mg

30

Valsartan/HCTZ

Co-Diovan

Tablets,
160mg/25mg

30

Valsartan/HCTZ

Co-Diovan

Tablet
160mg/12.5mg

30

Valsartan/HCTZ

Co-Diovan

Tablet,
80/12.5mg

30

Valsartan/HCTZ

Co-Diovan

Tablet,
320/25mg

30

84 NPDP Patient Guide

Description

Purple egg shaped

tablet; markings
NVR, DXL

Tan/brown oval
film-coated tablet;
markings HXH,
NVR

Red -brown, oblong

film-coated tablet;
markings HHH; CG

Pink, oblong film

coated tablet;
markings HGH, CG

Yellow oblong film

coated tablet;
markings CTI; NVR